Thursday, November 16, 2017

A new study conducted by researchers at The University of New Mexico, involving medical cannabis and prescription opioid use among chronic pain patients, found a distinct connection between having the legal ability to use cannabis and significant reductions in opioid use.

The study titled, “Associations between Medical Cannabis and Prescription Opioid Use in Chronic Pain Patients: A Preliminary Cohort Study,” and published in the open access journal PLOS ONE, was conducted by Drs. Jacob Miguel Vigil, associate professor, Department of Psychology and Sarah See Stith, assistant professor, Department of Economics. The results from this preliminary study showed a strong correlation between enrollment in the New Mexico Medical Cannabis Program (MCP) and cessation or reduction of opioid use, and that whole, natural Cannabis sativa and extracts made from the plant may serve as an alternative to opioid-based medications for treating chronic pain.

Today, opioid-related drug overdoses are the leading cause of preventable deaths in the United States killing approximately 100 Americans every day. Conventional pharmaceutical medications for treating opioid addiction, such as methadone and buprenorphine-tapering, can be similarly dangerous due to substantial risks of lethal drug interactions and overdose.

“Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives,” said Vigil, who led the study. “Our results highlight the necessity of more extensive research into the possible uses of cannabis as a substitute for opioid painkillers, especially in the form of placebo-based, randomized controlled trials and larger sample observational studies.”

Cannabis has been investigated as a potential treatment for a wide range of medical conditions from post-traumatic stress disorder to cancer, with the most consistent support for the treatment of chronic pain, epilepsy and spasticity. In the U.S., states, including New Mexico, have enacted MCPs in part for people with chronic, debilitating pain who cannot be adequately or safely treated with conventional pharmaceutical medications.

Like other states, New Mexico only permits medical cannabis use for patients with certain debilitating medical conditions. All the patients in the study had a diagnosis of “severe chronic pain,” annually validated by two independent physicians, including a board-certified specialist.

New Mexico, Vigil notes, is among the U.S. states hardest hit by the current opioid epidemic, although the number of opioid-related overdose deaths appears to have fallen in recent years, perhaps the result of increased enrollment in the NM MCP, which currently includes more than 48,000 patients.

“MCPs are unique, not only because they allow patients to self-manage their cannabis treatment, but because they operate in conflict with U.S. federal law, making it challenging for researchers to utilize conventional research designs to measure their efficacy,” Vigil said.

The purpose of the researchers’ preliminary, cohort study was to help examine the association between enrollment in a MCP and opioid prescription use. The study observed 37 habitual opioid using, chronic pain patients that chose to enroll in the MCP between 2010 and 2015, compared to 29 patients with similar health conditions that were also given the option, but ultimately chose not to enroll in the MCP.

“Using informal surveys of patients enrolled in the MCP, we discovered a significant proportion of chronic pain patients reporting to have substituted their opioid prescriptions with cannabis for treating their chronic pain,” said Vigil.

The researchers used Prescription Monitoring Program opioid records over a 21-month observation period (first three months prior to enrollment for the MCP patients) to more objectively measure opioid cessation – defined as the absence of opioid prescriptions activity during the last three months of observation, with use calculated in average daily intravenous [IV] morphine dosages. MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected.

By the end of the observation period, the data showed MCP enrollment was associated with a 17 times higher age- and gender-adjusted odds of ceasing opioid prescriptions, a 5 times higher odds of reducing daily prescription opioid dosages, and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10 percentage points in the non-enrolled patient group.

Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few negative side effects from using cannabis one year after enrollment in the MCP.

The researchers’ findings, which provide clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrant further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.

According to Stith, “The economic impact of cannabis treatment should also be considered given the current burden of opioid prescriptions on healthcare systems, which have been forced to implement costly modifications to general patient care practices, including prescription monitoring programs, drug screening, more frequent doctor-patient interactions, treatment of drug abuse and dependence, and legal products and services associated with limiting opioid-related liability.”

“If cannabis can serve as an alternative to prescription opioids for at least some patients, legislators and the medical community may want to consider medical cannabis programs as a potential tool for combating the current opioid epidemic,” Vigil said. (Source: UNM Newsroom Media Contact- Steve Carr, Supervisor, Communications University of New Mexico, scarr@unm.edu )

The New Mexico Medical Cannabis Advisory Board Hearing that was held on, Friday November 3rd 2017, at the New Mexico Department of Health was the second meeting for 2017. The advisory board consists of eight practitioners representing the fields of neurology, pain management, medical oncology, psychiatry, infectious disease, family medicine and gynecology. The practitioners shall be nationally board-certified in their area of specialty and knowledgeable about the medical use of cannabis. The members are chosen for appointment by the Secretary of Health from a list proposed by the New Mexico Medical Society.

The Medical Cannabis Advisory Board (MCAB) Duties and Responsibilities according the medical cannabis program law, LECUA Act 2007: The advisory board shall convene at least twice per year to: review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis; recommend quantities of cannabis that are necessary to constitute an adequate supply for qualified patients and primary caregivers; accept and review petitions to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis and all lawful privileges under the act and implementing rules; issue recommendations concerning rules to be promulgated for the issuance of registry identification cards; and review conditions previously reviewed by the board and approved by the secretary for the purpose of determining whether to recommend the revision of eligibility criteria for persons applying under those conditions or to review new medical and scientific evidence pertaining to currently approved conditions.

2017-44 Opioid Use Disorder: 11-06-2016 Vote of 5-1 to recommend, Secretary Gallagher denied the recommendation and did not add Opiate Use Disorder as a qualifying condition Petitioner for Opioid Use Disorder would like to present technical evidence from: -Petitioner -Dr. Steve Jenison - Drug Policy AllianceNovember Vote was-Recommended to add to MCP with 5-0 Vote

Petition Action & MCAB Vote (Y-N)

Medical Treatment Petitions:

Medical Treatment; Pediatric Oncology & Medical Cannabis Use for Antiemetic in State Hospitals-Recommended to add to MCP with 5-0 Vote by sending a letter of support to Legislature to add into LECUA Act, 2007.

Medical Treatment; Medical Cannabis Program Research & Education Established

(Petition was not heard at this meeting - “they are beyond the scope of the Medical Advisory Board.”)

(Petition was not heard at this meeting - “they are beyond the scope of the Medical Advisory Board.”)

Medical Treatment; Recognition of nonresident medical cards.

(Petition was not heard at this meeting - “they are beyond the scope of the Medical Advisory Board.”)

Medical Treatment; Adequate Supply: LNPP Plant Count Increase

(Petition was not heard at this meeting - “they are beyond the scope of the Medical Advisory Board.”)

3 of the 5 MCAB members made public comment that they feel this is part of the scope of work they do for the program and further said they (MCAB) should have been able to hear this petition as it does pertain to adequate supply in the medical cannabis program.

Medical Treatment; Increase MCAB membership

(Petition was not heard at this meeting - “they are beyond the scope of the Medical Advisory Board.”)